Abstract：
The optimization of positive end-expiratory pressure (PEEP) according to respiratory mechanics [driving pressure or respiratory system compliance (Crs)] is a simple and straightforward strategy. However, its validity to prevent postoperative pulmonary complications (PPCs) remains unclear. Here, we performed a meta-analysis to assess such efficacy. We searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) that compared personalized PEEP based on respiratory mechanics and constant PEEP to prevent PPCs in adults. The primary outcome was PPCs. Fourteen studies with 1105 patients were included. Compared with those who received constant PEEP, patients who received optimized PEEP exhibited a significant reduction in the incidence of PPCs (RR = 0.54, 95% CI 0.42 to 0.69). The results of commonly happened PPCs (pulmonary infections, hypoxemia, and atelectasis but not pleural effusion) also supported individualized PEEP group. Moreover, the application of PEEP based on respiratory mechanics improved intraoperative respiratory mechanics (driving pressure and Crs) and oxygenation. The PEEP titration method based on respiratory mechanics seems to work positively for lung protection in surgical patients undergoing general anesthesia.
摘要：
根据呼吸力学[驱动压力或呼吸系统顺应性（Crs）]优化呼气末正压（PEEP）是一种简单而直接的策略。然而,其预防术后肺部并发症(PPCs)的有效性尚不清楚.这里,我们进行了荟萃分析以评估此类疗效.我们搜索了PubMed,Embase,和Cochrane图书馆，以确定随机对照试验（RCT），比较基于呼吸力学和恒定PEEP预防成人PPC的个性化PEEP。主要结果是PPC。纳入了14项研究，1105名患者。与那些接受持续PEEP的人相比，接受优化PEEP的患者PPC发生率显著降低(RR=0.54,95%CI0.42~0.69).常见PPC的结果(肺部感染，低氧血症,肺不张而非胸腔积液）也支持个体化PEEP组。此外，基于呼吸力学的PEEP的应用改善了术中呼吸力学（驱动压力和Crs）和氧合。基于呼吸力学的PEEP滴定法似乎对全麻手术患者的肺保护具有积极作用。
